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ContextIt is unclear if blood transfusion in anemic patients with acute coronary syndromes is associated with improved survival.ObjectiveTo determine the association between blood transfusion and mortality among patients with acute coronary syndromes who develop bleeding, anemia, or both during their hospital course.Design, Setting, and PatientsWe analyzed 24 112 enrollees in 3 large international trials of patients with acute coronary syndromes (the GUSTO IIb, PURSUIT, and PARAGON B trials). Patients were grouped according to whether they received a blood transfusion during the hospitalization. The association between transfusion and outcome was assessed using Cox proportional hazards modeling that incorporated transfusion as a time-dependent covariate and the propensity to receive blood, and a landmark analysis.Main Outcome MeasureThirty-day mortality.ResultsOf the patients included, 2401 …